Abstract:

Objective To investigate the risk factors of early stage renal replacement therapy for acute kidney injury after heart transplantation and its effect on short-term prognosis. Methods We retrospectively studied 77 consecutive heart transplant recipients from January 2013 to June 2019，15 patients of them accepted renal replacement treatment for acute kidney injury at early stage（RT group），and the other 62 patients didn`t（NRT group）. The age，BMI，protopathy，renal function before operation，operation model，duration of cardiopulmonary bypass，aortic crossclamp time，volume of blood transfusion and fresh frozen plasma transfusion were comparedbetween the two groups，and the 28 d mortality were analyzed. Results The patients of RT group were older thanthat of NRT group〔（58.70±7.70）years vs（52.80±12.70）years，P ＝ 0.028〕. The estimated glomerular filtration rate（eGFR）before operation were much lower in RT group〔（61.00±22.86）ml/min vs（75.34±25.16）ml/min，P ＝ 0.048〕. And more fresh frozen plasma were transfused to patients of RT group〔（1423.33±572.44）ml vs（1053.71±560.77）ml，P ＝ 0.024〕. Besides，most patients accepted heart transplantation，two patients in RT group accepted intra-aortic balloon pulsation simultaneously and 1 patients in NRT group accepted combinedcardiopulmonary transplantation. Patients with renal replacement therapy had a greater 28 d mortality（53.33% vs 8.06%，P ＜ 0.001）. Conclusion The early stage renal replacement therapy after heart transplantation is a frequent complication associated with a high short-term mortality and is mainly associated with older age，preoperative renal function impairment and more fresh frozen plasma transfusion during operation.

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摘要：

目的 分析心脏移植术后因急性肾损伤接受肾脏替代治疗的风险因素，及其对术后短期预后的影响。方法 回顾性分析 2013 年 1 月—2019 年 6 月单中心接受心脏移植术后早期因急性肾衰接受肾脏替代治疗患者（RT 组，15 例）与非肾脏替代治疗组患者（NRT 组，62 例）在年龄、体重指数、术前肾功能及手术方式、体外循环时间、主动脉阻断时间、术中输注红细胞量、输注血浆量等方面的差异，以及两组患者术后 28 d 内预后的差别。结果 RT 组患者年龄显著大于 NRT 组〔（58.70±7.70）岁比（52.80±12.70）岁，P ＝ 0.028〕，术前估算肾小球滤过率显著低于 NRT 组〔（61.00±22.86）ml/min 比（75.34±25.16）ml/min，P ＝ 0.048〕。RT 组患者有 2 例接受心脏移植 + 主动脉内球囊反搏术，NRT 组 1 例为心肾联合移植，其余均为单纯心脏移植，RT 组患者术中输注血浆量多于 NRT 组〔（1 423.33±572.44）ml 比（1 053.71±560.77）ml，P ＝ 0.024〕。RT 组患者术后 28 d 内病死率显著高于 NRT 组（53.33% 比 8.06%，P＜0.001）。结论 心脏移植术后早期因严重肾损伤而接受肾脏替代治疗是常见而严重的并发症，与患者年龄、术前肾功能受损、术中大量输注血浆等因素相关，是导致术后早期患者死亡的主要危险因素。

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